Flat Feet in Children

It is normal for babies and toddlers to have 'flat feet' due to the presence of fatty tissue on the insoles of their feet. This persists until approximately four - six years of age. Many children present with 'flexible flat feet', early in their walking development and may well grow out if it as their walking matures and they develop a longitudinal arch. Walking in bare in feet is ideal for promoting foot development.


Referral Criteria

Referral not necessary if: -
  • the child is under four years of age
  • asymptomatic
  • the longitudinal arch forms normally when the child stands on tip-toe or when the big toe is passively extended
Consider referral if :-
  • patient aged over 4 and has significant pain in feet – consider direct referral to orthotics (orthotics not advised if no foot pain)
  • there are signs of pressure on the foot e.g. blistering or callosities.
  • the longitudinal arch does not form normally when the child stands on tip-toe.
  • the foot is stiff (i.e the normal arch does not form when the child stands on tip-toe or the big toe is passively extended) - example of stiff flat feet shown (due to tarsal coalition)
  • patient has significant knee pain associated with flat feet

Referral Instructions

e-Referral Service Selection

  • Specialty: Children's and Adolescent Services
  • Clinic Type: Orthopaedics
  • Service: DRSS-Western-Orthopaedics- Devon CCG-15N

Referral Forms

DRSS Referral Proforma

S​upporting Information

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG.

Publication date: May 2017


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